Role of recombinant factor VIIa in the treatment of intractable bleeding in vascular surgery

Abstract

Our findings suggest that rFVIIa may play a role in controlling the intractable perioperative and postoperative bleeding in surgical patients undergoing a repair of RAAAs and TAAAs. Certainly, prospective randomized trials are necessary to further confirm the efficacy and cost-effectiveness of rFVIIa in these patients.

Investigation of Outcomes Following Recombinant Activated FVII Use for Refractory Bleeding During Abdominal Aortic Aneurysm Repair

“…28 Various mechanisms are implicated in coagulopathy: tissue injury can lead to platelet and clotting factor consumption (consumption coagulopathy), prolonged operation time, global hypoperfusion and intraoperative replacement of large volumes of non-warmed fluids can contribute to both hypothermia and dilutional coagulopathy. 9 In addition, hypoperfusion due to crossclamping and subsequent reperfusion after unclamping is thought to induce fibrinolysis and acidosis. In turn, both hypothermia and acidosis can contribute to clotting factor dysfunction, resulting in refractory coagulopathy.…”

“…In turn, both hypothermia and acidosis can contribute to clotting factor dysfunction, resulting in refractory coagulopathy. 9 Modern management of patients undergoing AAA repair with perioperative haemorrhage includes cell salvage mechanisms, rapid administration of large amounts of red blood cells (RBCs), platelets and plasma to prevent and treat coagulopathy. 9,11 Additionally, procedures to minimise hypothermia (e.g.…”

“…9 Modern management of patients undergoing AAA repair with perioperative haemorrhage includes cell salvage mechanisms, rapid administration of large amounts of red blood cells (RBCs), platelets and plasma to prevent and treat coagulopathy. 9,11 Additionally, procedures to minimise hypothermia (e.g. use of warm fluid infusion, forced air warming and warm saline in surgical field) and correction of acidosis at an early stage, may be used to prevent coagulopathy.…”

“…However, due to uncontrolled haemorrhage and coagulopathy, many patients do not survive surgical intervention. 9 Mechanisms postulated to be associated with coagulopathy in r-AAA patients include consumption of platelets and clotting factors within aneurysmal thrombi, dilution of clotting factors and platelets through blood loss, fluid therapy and blood transfusions and the adverse effects of acidosis and hypothermia on platelet function. 10,11 Consequently, there is growing interest in adjunctive therapies for treating critical bleeding in AAA patients.…”

“…20 In AAA, data on the use of rFVIIa is scarce; however, case reports and series suggest that effective administration of rFVIIa may be associated with improved patient outcomes. 9,21,22 In this manuscript, we sought to describe the use of rFVIIa in patients diagnosed with AAA (ruptured and nonruptured) and their outcomes, using data from the Australian and New Zealand Haemostasis Registry (ANZHR). In addition, we compared the expected versus observed mortality in ANZHR AAA patients in different severity strata using published mortality prediction models.…”